How do
patients learn the skills that they need?Patients
learn through practicing a skill and receiving feedback or guidance. It is
easy to understand how patients need practice when performing a procedural
skill, yet practice activities are important with cognitive skills too. Having
patients practice allows you to check whether they can demonstrate if they
have learned what you have intended (whether it is following a sequence of
instructions, explaining their understanding, recognizing symptoms of peritonitis,
or other skills). When patients first begin to practice new skills, you can
expect to be involved in providing much guidance and help, even in familiar
activities such as washing their hands.

Practice activities must
be related to the intended learning outcome for the patient. If the outcome
has many steps to remember, try to develop smaller practice activities to
help the patient learn the larger goal. Your entire training program is made
up of smaller lessons. The following chart illustrates the direct link between
a learning outcome and a practice activity

LEARNING
OUTCOME

PRACTICE
ACTIVITY DIRECTIONS

To inspect the solution
fluid prior to using it.

“Here’s
a bag of solution. Show me what you would do before you would use this
bag, and tell me the steps as you go through them.”

To identify and
describe the role of the peritoneum.

“Here’s
a picture of the body. Can you show me where the peritoneum is and describe
how the fluid replacement works?”

To differentiate
cloudy and clear solution bags

“Here are
two different bags of fluid; can you tell me which one of them is clear?
Here is another example a bit more difficult – can you point out
the difference now?”

To solve a potential
problem.

(Pose problems that
might occur). “What would you do if you accidentally dropped the
cap onto the floor?”

To connect tubing.

“Now that
I’ve shown you how to do this, try reading the directions aloud
as you connect the tubing to the machine.”

How
can I increase the value of practice activities?
Practice activities are most effective if they occur right after new information
has been presented. If you are teaching a patient how to connect to a machine,
you would first demonstrate making the connection, then immediately have the
patient attempt or practice that same activity under your supervision.

Practice activities are more effective if integrated in small
steps throughout the lessons rather than having patients try to remember large
amounts of information on a daily basis.

Once a skill is learned, you will want to reinforce it with
further practice. You can strengthen previous learning by asking patients
to recall specific information, particularly if that information is important
to the next skill that they must master. For example, you might ask your patients
to summarize the importance of the aseptic technique prior to teaching them
how to make connections. This type of practice further strengthens the idea
that maintaining a sterile field is important as they learn the new procedures.

Finally, practice should
progress from easy to hard. If you want patients to tell the difference between
cloudy and clear bags, present two bags that are easily differentiated. Then
present another bag where it is harder to tell the difference. Presenting
easier questions first builds confidence in your patients, and allows you
to assess whether a basic understanding is achieved.

Watch the patient as
he goes through the following sequence of practice activities:

1.
Beginning the procedure
Mary has already simplified the initial process of warming the bag and
preparing the supplies. The patient is expected to begin the tasks of
checking the quality of the bag, putting on a mask, and disinfecting
his hands.

2.
Hanging the bag and untangling the tubing
When working with new materials, patients are not familiar with the
products and could be worried about breaking the tubing or bag. Unless
the patient is very frustrated, confine your corrections to verbal guidance
and nurturing and resist the urge to physically help the patient. This
is how patients learn to work with the supplies.

3.
Maintaining the sterile field
Connecting and disconnecting correctly are vital to the health of the
patient. When the patient is performing these small tasks, Mary is vigilant
as to how and what the patient touches. It is essential that this skill
must be learned and demonstrated correctly in order to avoid future
contamination.